Oversized cancer drug vials lead to billions in waste annually

One-size-fits-all cancer drug vials have resulted in Medicare and insurers wasting nearly $3 billion each year, according to a study published in BMJ.

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Researchers from Memorial Sloan Kettering Cancer Center analyzed the top 20 infused cancer drugs by projected 2016 sales in the United States that are dosed based on body size and packaged in single-dose vials.

Saltz

“Using the most efficient combination of available vial sizes, we calculated the proportion of each drug’s projected sales that come from drug that is administered to a patient versus the amount that would be discarded,” says study coauthor Leonard Saltz, MD, professor of medicine, Weill Cornell Medical College and chief, Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center.

“We utilized a representative sample of patients’ body sizes and determined the patients’ doses by using the lowest dose within the first FDA-approved indication for the drug,” Saltz says.

They calculated that drug manufacturers will earn about $1.8 billion from leftover cancer drugs in the United States this year, with another $1 billion from billing doctors and hospitals for leftover drugs. 

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Many infused cancer drugs are packaged in single-dose vials but dosed based on body size, which often results in leftover drug.

“Currently, the entire vial is paid for, regardless of how much drug was infused into the patient versus discarded. By marketing drugs in oversized vials and not also providing smaller vials to allow for individual size-based doses with minimal waste, manufacturers can sell more drug for each patient and so increase profits,” Saltz says.

The researchers estimate that this year in the United States, leftover drug from the top 20 cancer drugs fitting the criteria will result in $1.8 billion in waste.

“We do not believe that this phenomenon is accidental, and cite instances in which smaller vials sizes are available in Europe but not in the U.S.,” Saltz says. “We also note that strategies that espouse ‘flat dosing’ do not solve the problem, but rather mask it, by instead depositing excess drug beyond that which is necessary into the patient rather than the trash, again to no clinical benefit.”

The researchers propose that drug waste could be reduced by requiring manufacturers to provide drugs in a reasonable set of sizes.

The researchers propose requiring manufacturers to package drugs in quantities that allow for minimal wastage, or enabling the “virtual return” of leftover drug, paying only for drug that is appropriated given to the patient.   

“To prove this, we added just one additional vial to the currently available vial sizes for each drug,” Saltz says. “If our suggested vial sizes were implemented, revenue from waste could be reduced by approximately 75%, from $1.8 billion to $400 million. We thus show that there are ways to simply, but significantly, decrease waste.”

As healthcare expenditures continue to rise, opportunities to reduce waste have become increasingly important, according to Saltz. “It is necessary to be aware of the fact that as a system, we are not only paying for the dose that is being administered to the patient, but also for drug that is going directly into the trash,” he says. “Not only is this illogical, but it is an unnecessary source of waste that could be easily minimized. Decreasing this drug wastage provides a rare opportunity for substantial savings, one which can be implemented fairly easily without having any detrimental effect on the health of patients.”

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